Survival impact of capsule rupture in stage I clear cell carcinoma of the ovary in comparison with other histological types

• Published in: Gynecologic oncology 2011-12, Vol.123 (3), p.474-478
• Main Authors: Higashi, Makiko, Kajiyama, Hiroaki, Shibata, Kiyosumi, Mizuno, Mika, Mizuno, Kimio, Hosono, Satoyo, Kawai, Michiyasu, Nakanishi, Toru, Nagasaka, Tetsuro, Kikkawa, Fumitaka
• Format: Article
• Language: English
• Subjects: Adenocarcinoma, Clear Cell - drug therapy; Adenocarcinoma, Clear Cell - mortality; Adenocarcinoma, Clear Cell - pathology; Adenocarcinoma, Clear Cell - surgery; Adolescent; Adult; Aged; Analysis of Variance; Capsule status; Chemotherapy, Adjuvant; Clear cell carcinoma of the ovary; Disease-Free Survival; Epithelial ovarian carcinoma; Female; Hematology, Oncology and Palliative Medicine; Humans; Intraoperative Complications - mortality; Intraoperative Complications - pathology; Japan - epidemiology; Long-term survival; Middle Aged; Multivariate Analysis; Neoplasm Recurrence, Local - mortality; Neoplasm Recurrence, Local - pathology; Neoplasm Staging; Obstetrics and Gynecology; Ovarian Neoplasms - drug therapy; Ovarian Neoplasms - mortality; Ovarian Neoplasms - pathology; Ovarian Neoplasms - surgery; Recurrence site; Retrospective Studies; Rupture, Spontaneous; Survival Rate; Young Adult
• ISSN: 0090-8258; 1095-6859
• DOI: 10.1016/j.ygyno.2011.08.036

Abstract Objective We analyzed a large number of stage I clear cell carcinoma of the ovary (CCC) patients to estimate the survival impact of the capsule status in stage I CCC patients, particularly in comparison with non-CCC patients. Methods Clinicopathologic data on 564 patients with stage I epithelial ovarian cancer (EOC) collected under the central pathological review system were subjected to uni- and multivariable analyses to evaluate the disease-free survival (DFS) and overall survival (OS). Results There was no significant difference in both the OS and DFS of CCC patients between IA and IC(ir) (intraoperative capsule rupture) {IA vs. IC(ir); OS: P = 0.1402, DFS: P = 0.2701}. In contrast, CCC patients at IC(non-ir) {IC excluding for IC(ir), such as preoperative capsule rupture, positive ascites/washing, and surface involvement} showed a poorer OS and DFS than those at IC(ir), or those at the corresponding stage in non-CCC. In multivariable analysis, the capsule status was an independent prognostic factor of a poor OS and DFS {OS: HR, 2.832; 95% CI 1.156–6.938; P = 0.023; DFS: HR, 4.327; 95% CI, 1.937–9.667; P = 0.0004)} {In contrast, non-CCC: N.S. (OS/DFS)}. Furthermore, in CCC patients, intraperitoneal recurrences were more frequently observed in IC(non-ir) CCC than IA or IC(ir) CCC ( P = 0.0083) {In contrast, non-CCC: N.S. }. Conclusion This study suggests that CCC patients other than those with intraoperative capsule rupture show a considerable risk for mortality despite adjuvant chemotherapy.